- Insight Global (Boston, MA)
- …will fall within the Clinical Performance, Operations, and Innovation organization. The UM Director is responsible for reviewing and providing guidance for ... Job Description Insight Global is sourcing for a Utilization Management Director to join a not-for-profit community based healthcare organization within the… more
- CenterWell (Boston, MA)
- …a part of our caring community and help us put health first** The Medical Director , Primary Care relies on medical background and reviews health claims. The Medical ... Director , Primary Care work assignments involve moderately complex to...teams or organizational committees. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Humana (Little Rock, AR)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Jefferson City, MO)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... how to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all submitted medical records, synthesizing complex… more
- Centene Corporation (Jefferson City, MO)
- …reimbursement, paid time off plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay will be adjusted based on ... an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene… more
- University of Michigan (Dearborn, MI)
- …The Assistant Director of Alumni Engagement provides leadership for increasing UM -Dearborn's ability to engage alumni in the life of the university. This ... Assistant Director of Alumni Engagement Apply Now **How to...outreach, and improve the connection our alumni have with UM -Dearborn. The successful candidate will develop and execute programs… more
- CVS Health (Springfield, IL)
- …in inter-rater review activities and other quality oversight processes for internal Director UM decisions. If specifically assigned to one business segment ... Board Certified Oncologist for this opportunity. This is a remote based from from home role. The Medical Affairs...in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior… more
- Humana (Indianapolis, IN)
- …of behavioral and physical health services, including Utilization Management ( UM ), Quality Improvement, and value-based payment programs. The Chief Psychiatrist ... collaborative care models in their practices + Coordinates with the Medical Director to integrate the administration and management of behavioral and physical health… more
- University of Michigan (Ann Arbor, MI)
- Center Assistant Director Apply Now **How to Apply** Interested applicants should provide a cover letter detailing their specific interest in the position, CV and ... of Earth and Environmental Science, (https://lsa.umich.edu/earth) is looking for a Center Assistant Director . The Assistant Director will be a key leader in the… more
- Tufts Medicine (Burlington, MA)
- Location: Remote with occasional onsite travel required **Job Overview** The position is responsible for CDI program strategy and oversight. The Director will ... multiple revenue cycle and hospital departments, such as Coding, Utilization Management ( UM ), Case Management, Quality and Physician advisors and leaders. The … more
- University of Michigan (Ann Arbor, MI)
- CLINICAL NURSING DIRECTOR (CS Mott Children's Hospital: 10-West Pediatric Cardiothoracic Intensive Care Unit- PCTU) Apply Now **Job Summary** The Pediatric ... patient care. Reporting Relationship: The 10W PCTU Clinical Nursing Director reports to the Associate Chief Nursing Officer for...of Work** Positions that are eligible for hybrid or mobile/ remote work mode are at the discretion of the… more
- University of Michigan (Ann Arbor, MI)
- Admin Director Healthcare Apply Now **Job Summary** The Senior Director for Enterprise Disinfection & Sterilization Services is responsible for providing ... and PowerPoint. **Modes of Work** Positions that are eligible for hybrid or mobile/ remote work mode are at the discretion of the hiring department. Work agreements… more
- Integra Partners (Troy, MI)
- …call center and other internal & external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly to change ... The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director ) with administrative and non-clinical tasks related to processing… more
- Integra Partners (Troy, MI)
- The Utilization Management ( UM ) Nurse Supervisor is responsible for providing direct leadership and oversight to the UM nursing team. This role ensures team ... for frontline staff. Salary: $75,000.00/Annually JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The UM Nurse Team Lead's responsibilities include but are not limited… more
- CVS Health (Columbus, OH)
- …8:00am-5:00pm EST (Shift times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division of ... the lives of patients facing complex medical journeys. As a Utilization Management ( UM ) Nurse Consultant specializing in Medical Review, you'll play a vital role in… more
- Integra Partners (Troy, MI)
- …This individual will play a key role in collaborating with our Medical Director to perform benefit and medical necessity reviews and appeals within an NCQA-compliant ... UM program. Salary: $60,000.00/annual JOB QUALIFICATIONS: KNOWLEDGE/SKILLS/ABILITIES The ...medical necessity criteria + Refer cases to the Medical Director that do not meet medical necessity criteria +… more
- AmeriHealth Caritas (LA)
- …to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible to ensure ... perform a thorough medical necessity review. It is within the BH UM Reviewer's discretion to retain requests for additional information and/or request clarification.… more
- University of Michigan (Flint, MI)
- …Conferences & Events - Event Supervisor. This position will report to the Director of Conferences and Events. The Event Supervisor is responsible for overseeing ... 3p-9p (1/2 hour lunch period) **Responsibilities **Manage Events at UM -Flint** + On-site event management + Event setup, teardown...of Michigan. Positions that are eligible for hybrid or mobile/ remote work mode are at the discretion of the… more
- University of Michigan (Flint, MI)
- …sustainable internship program. The position reports directly to the Director of Student Support Services. **Responsibilities **Program Development:** + Collaborate ... the Comprehensive Benefits for Faculty and Staffflier (https://hr.umich.edu/sites/default/files/benefit-highlights.pdf) . UM -Flint offers tuition support for eligible UM -Flint… more
- AmeriHealth Caritas (Philadelphia, PA)
- …www.amerihealthcaritas.com . **Responsibilities:** Under the supervision of the LTSS Manager/ Director for Utilization Management, this position is responsible for ... operations of the LTSS Review Home Modification and LTSS UM Department, including authorization and approval of services, appeals...as needed. + Travel as determined by manager and/or director to meet the needs of the business in… more